DESCRIPTION (Applicant's abstract): Bipolar disorder (BPD), a lifelong condition affecting almost 2 million Americans, is the sixth leading cause of disability among all medical conditions in established market economies. The illness is characterized by a chronic course of recurring cycles of affective disorder (e.g., mania or depression) and remission. Despite the magnitude of its affliction and its disability toll, there has been little or no systematic research on the causes of the disability in life functioning (LF) in BPD. Disability in LF is found to persist even during periods of system remission and should not be considered simply the result of clinical psychopathology. Neuropsychological (NP) deficits have been observed in BPD. The NP deficits, like disability in BPD, have also been shown to persist during remission. While the relation between NP deficits and disability in schizophrenia receives considerable research attention, such studies for BPD have not been reported to the best of our knowledge. We propose a longitudinal investigation of the relationship between NP deficits and LF in BPD. We hypothesize that NP deficits are associated with persistent disability. Our goal is to study the nature of these relationships thereby informing the development of more effective interventions targeted to disability in BPD. A sample of 210 patients will be followed monthly, starting with an acute illness exacerbation, for a period of 2 years. Subjects will undergo repeated assessments for NP and LF measures and clinical state. Comprehensive assessments including an NP battery are administered at 3 "fixed" time points (baseline, 1 month and 1 year) and at up to 2 additional time points "triggered" by a remission following the index episode and a remission following a second illness episode should a second episode occur during the follow-up period. Monthly assessments will monitor clinical state, LF and services used throughout the follow-up period. The principal aim is to determine whether and to what degree measures of NP deficit and clinical symptom ratings are associated with disability in LF over the course of a 24 month period. Secondary aims are 1) to compare these relationships in BPD with those observed in a cohort of individuals with schizophrenia and schizoaffective disorder presently being studied in another R01 funded project and 2) to acquire descriptive information of actual service use patterns in BPD patients recovering from a severe relapse of affective symptoms. More effective rehabilitation and support services are needed to reduce disability in BPD. But first we need a better understanding of the causes of disability and the services currently being provided.